HomeMy WebLinkAboutX2016-2868 - Permit ApplicationPnnt Fore; '} Worksheet for Combo Building & Solar Permit Application OY�,,
❑ Comm'I L Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ilding ❑ Grading
Address
832-
❑Drainage ❑ Elec ❑ Mech ❑ Plum
Cu Yd Fill
g address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
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New/Add SFRemodel SFGarage/New/Add
OWNER'S NAME Last First
Use I K3//A Const Type
# Starie's Ems® # Units (if Res)Ul
5
abor $ I a G d
Owner's Address Owner's E-mail Address _( M ( r� -_ r (C✓!o
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City I State Zip Telephone
APPLICANT'S NAME Last
Applicant's Address
City State
First
Applicant's E-mail Address
Zip Telephoned
ARCHITECT NGR'S NAME Last First 1
1(1�I
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip �' Telephoned
ENGINEER'S NAME Last First Lic. No.�
Engineer's Address
City __j State
Engineer's E-mail Address
Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class F-1
Contractor's Address
City _ State^
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip Telephoned
PERMIT NO. %.Gfl( ID —
PLAN CHECK NO. I`1 M �
USE ZONE
QAI� -�.
DEVELOPMENT NO
PLAN CHECK FEES $